AboutAdelaide Rose Expertise Any questions related to Revenue Cycle Management and homecare/facilities operation processes.
Experience I have been in the healthcare industry since 1992. My experience comes from working in a multi-physician practice setting, homecare, ambulatory care and consulting engagements with a "Big 5" firm.
Question My daughter, age 27, is disabled. Her Dad carries her on his Federal BC/BS policy and she has Medicare. I have used BC/BS as primary and Medicare as secondary. Recently, Horizon BC/BS advised that Medicare should be primary and BC/BS secondary, as my daughter's Dad is retired. I did not know this and will be happy to change.
However, BC/BS has gone back 5 years and is pulling payments from all my daughter's doctors (a lot) and demanding repayment for the past 5 years. BC/BS is telling providers to bill Medicare, but Medicare only pays for the past 18 months.
How can they do this? Now the providers are billing me for the FULL amounts billed, not the allowable amounts.
What can I do about this? Calls to BC/BS have not provided any answers.
Thank you so much.
Answer Betsy,
Depending on the state, the limitations to be able to go back are different. Most states it's only 18 months (I know NJ is).
I would suggest that you contact your state Department of Insurance (sometimes this falls under the banking department) and ask them what is the time limit. In addition, this department is responsible for overseeing the insurance companies, and if they are not following the rules you can file a complaint.
Good luck.
PS: you do not mention on your e-mail which state you're in.
